Provider Demographics
NPI:1710066568
Name:COLORADO WEST WOMANCARE PC
Entity Type:Organization
Organization Name:COLORADO WEST WOMANCARE PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MISS
Authorized Official - First Name:GLENDA
Authorized Official - Middle Name:
Authorized Official - Last Name:HUDSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:970-243-7908
Mailing Address - Street 1:750 WELLINGTON AVE
Mailing Address - Street 2:SUITE 3C
Mailing Address - City:GRAND JUNCTION
Mailing Address - State:CO
Mailing Address - Zip Code:81501-6132
Mailing Address - Country:US
Mailing Address - Phone:970-243-7908
Mailing Address - Fax:970-245-0656
Practice Address - Street 1:750 WELLINGTON AVE
Practice Address - Street 2:SUITE 3C
Practice Address - City:GRAND JUNCTION
Practice Address - State:CO
Practice Address - Zip Code:81501-6132
Practice Address - Country:US
Practice Address - Phone:970-243-7908
Practice Address - Fax:970-245-0656
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-03
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO207V00000X207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGroup - Single Specialty